17056 Heart Block

Overview

Heart block is a problem with the electrical system that controls your heartbeat. It means the electrical signals that tell your heart to beat are delayed or blocked. This can make your heart beat too slowly or irregularly. It is not the same as a blocked blood vessel, and it is not a heart attack.

Heart block is not as common as other heart conditions, but it does affect many people, especially older adults and those with heart disease. Mild forms may be found by chance during a heart test.

Heart block can happen at any age, including in children who are born with it. It is most common in older adults and in people who have had heart attacks, heart surgery, or certain infections.

Symptoms

Common symptoms

• Dizziness or light-headedness
• Fainting or nearly fainting
• Extreme tiredness (fatigue)
• Shortness of breath, especially with activity
• Chest pain or discomfort
• A heartbeat that feels slow, irregular, or like it is skipping beats

Symptoms in children

• Feeding difficulties or poor appetite in babies
• Being unusually sleepy or tired
• Slow growth or weight gain
• Fainting or dizzy spells
• Turning pale or blue around the lips

Symptoms in older adults

• Confusion or trouble concentrating
• Unexplained falls
• Feeling weak or tired all the time
• Swelling in the legs or ankles
• Breathlessness with everyday activity

Causes

Main causes

• Aging of the heart's electrical system
• Heart attack or damage to heart tissue
• Previous heart surgery, especially on the valves or around the heart
• Infections that affect the heart, such as Lyme disease or rheumatic fever
• Some medicines that slow the heart rate, like beta-blockers or calcium channel blockers
• Being born with a heart defect (congenital heart block)

Risk factors

• Older age
• High blood pressure or coronary artery disease
• A history of heart attack or heart surgery
• Untreated underactive thyroid (hypothyroidism)
• Electrolyte imbalances, such as low potassium or magnesium
• Family history of heart block or arrhythmias

When to see a doctor

See a doctor urgently if:

• You faint, have chest pain, or feel severely short of breath
• Your heartbeat feels very slow, very fast, or irregular
• You have new dizziness or confusion

Book a routine appointment if:

• You often feel dizzy, tired, or weak and don't know why
• You notice your pulse is often below 60 beats per minute
• You have heart disease and notice any change in your symptoms

Diagnosis

A doctor will ask about your symptoms, check your pulse and blood pressure, and listen to your heart. They may also ask about your medical history and medicines. The main test is an electrocardiogram (ECG), which records the electrical activity of your heart.

Tests that may be done

• Electrocardiogram (ECG or EKG) – a quick, painless test with sticky patches on your chest
• Holter monitor – a portable ECG you wear for 24 to 48 hours to record your heart around the clock
• Event monitor – a small device you press when you feel symptoms, worn for weeks
• Echocardiogram – an ultrasound of the heart to check its structure and function
• Blood tests – to check for infections, electrolyte problems, or thyroid issues

What to expect at your appointment

These tests are painless and do not require needles for most of them. You may need to wear a monitor at home for a few days. Your doctor may also refer you to a cardiologist, a doctor who specialises in heart problems.

Treatment

Treatment depends on the type and severity of heart block. Mild heart block may not need any treatment. More serious heart block may need a pacemaker, a small device that helps keep the heart beating at a regular pace. Your doctor will explain which option is right for you.

Self-care at home

• Keep track of your symptoms and pulse, and report any changes to your doctor
• Tell your doctor about all medicines you take, including over-the-counter products
• Avoid using illegal drugs or stimulants, which can harm your heart rhythm
• Stay active but stop if you feel dizzy or breathless
• Follow up with your healthcare appointments and tests

Medical treatments

If heart block is caused by an underlying problem, like an infection or low thyroid, treating that problem may help. Some medicines that slow the heart may be changed or adjusted by your doctor. Do not stop or change any heart medicine on your own. For significant heart block, the main treatment is a pacemaker, which is implanted under the skin near your collarbone to send tiny electrical signals that keep your heartbeat normal.

When is surgery considered?

Pacemaker placement is a type of minor surgery. It is usually done under local anaesthetic, meaning you are awake but the area is numbed. Most people go home within a day and can return to normal activities within a few weeks.

Living with this condition

If you have heart block, you will need regular checkups to monitor your heart. Carry a list of your medicines and kidney health card if you have a pacemaker. Learn to check your pulse and know what is normal for you. Most people can work, travel, and enjoy daily activities with the right treatment.

Lifestyle tips

• Eat a heart-healthy diet full of vegetables, fruits, whole grains, and lean protein
• Stay physically active as advised by your doctor
• Avoid smoking and limit alcohol
• Manage stress with relaxation exercises, breathing techniques, or hobbies
• Get enough sleep and rest when you feel tired

Diet and exercise

A balanced diet can help control blood pressure, cholesterol, and weight. In most cases, gentle activities like walking, swimming, or cycling are safe and good for your heart. Always ask your healthcare team before starting a new exercise programme, especially after a pacemaker.

Mental health and emotional wellbeing

Living with a heart condition can cause anxiety, worry, or low mood. It is normal to feel this way. Talk to your doctor or a counsellor about how you feel. You don't have to manage it alone.

Prevention

You cannot always prevent heart block, especially if you were born with it. But you can lower your risk by treating high blood pressure, high cholesterol, and diabetes, by avoiding heart infections, and by managing existing heart disease under your doctor's care.

Vaccines

Staying up to date with recommended vaccines, such as the flu and pneumococcal vaccines, may help prevent infections that could affect the heart.

Screening programmes

If you have a higher risk of heart block, for example because of a family history or prior heart surgery, your doctor may recommend regular ECGs. There is no routine blood test for heart block, but blood tests can check for causes.

Complications

If left untreated

• Frequent fainting or falls, which can cause injuries
• Heart failure, where the heart can't pump blood well enough
• Cardiac arrest, where the heart stops beating (this is an emergency)

Long-term outlook

With the right diagnosis and treatment, the outlook for heart block is very good. Many people with a pacemaker live long, active lives and feel much better after treatment. Even if you need a pacemaker, most people quickly adapt and return to their normal routine. Your healthcare team will support you at every step.

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